疗前绝对淋巴细胞计数及其相关参数比对局部晚期宫颈癌患者疗效的预测价值

doi:10.3760/cma.j.cn113030-20201022-00507

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摘要目的探讨治疗前绝对淋巴细胞计数(ALC)及其中性粒-淋巴细胞比(NLR)、单核细胞-淋巴细胞比(MLR)以及血小板-淋巴细胞比(PLR)对局部晚期宫颈癌(LACC)患者预后的预测价值。方法纳入2016—2019年间新疆医科大学附属肿瘤医院收治的初诊LACC患者175例,完整记录患者的临床资料及治疗前ALC并计算NLR、MLR、PLR。采用Cox模型分析LACC患者的预后预测指标。结果 NLR降低组(<3.34)、MLR降低组(<0.315)LACC患者的无进展生存(PFS)均高于二者升高组(均P<0.05);ALC升高组(≥1.375×10⁹/L)、PLR降低组(<160.575)LACC患者的总生存(OS)均高于ALC降低组和PLR升高组(均P<0.05)。单因素分析显示高危CTV(HR-CTV)的等效剂量EQD2Gy是影响LACC患者PFS的重要预后因素(P=0.03),多因素分析显示FIGO分期(HR=2.339,95%CI为1.22~4.48,P=0.010)、同步放化疗(HR=0.213,95%CI为0.11~0.43,P<0.001)是LACC患者PFS的独立预测因素;而同步放化疗(HR=0.229,95%CI为0.07~0.81,P=0.023)和MLR(HR=4.933,95%CI为1.39~17.54,P=0.014)是LACC患者OS的独立预测因素。结论局部晚期宫颈癌患者能在同步放化疗中获益,HR-CTV EQD2Gy剂量是影响LACC患者PFS的重要预后因素,治疗前MLR升高是影响LACC患者OS的独立预后因素。

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	王玉婷
	秦永辉
	赵敏
	王若峥

关键词 ：单核细胞-淋巴细胞比, 宫颈癌,局部晚期/同步放化疗法, 预后

Abstract：Objective To investigate the prognostic value of absolute lymphocyte count (ALC) and neutrophil-lymphocyte ratio (NLR),macrophage-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR) before treatment in patients with locally advanced cervical cancer (LACC). Methods A total of 175 patients newly-diagnosed with LACC admitted to Cancer Hospital affiliated to Xinjiang Medical University from August 2016 to October 2019 were enrolled in this study. Complete clinical data and ALC before treatment were recorded and NLR, MLR and PLR were calculated. Multivariate Cox′s proportional hazard regression model was used to analyze the prognostic factors of patients with LACC. Results The progress-free survival (PFS) of LACC patients in the NLR reduction group (<3.34) and MLR reduction group (<0.315) were significantly higher than those in the NLR and MLR elevation groups (both P<0.05). The overall survival (OS) of LACC patients in the ALC elevation group (≥1.375 × 10⁹/L) and the PLR reduction group (<160.575) were significantly higher compared with those in the ALC reduction group and PLR elevation group (both P<0.05). Univariate analysis showed that EQD2Gy, the equivalent dose of HR-CTV, was an important prognostic factor of PFS in patients with LACC (P=0.030). Multivariate Cox's regression analysis demonstrated that FIGO staging (HR=2.339, 95%CI 1.22-4.48, P=0.010) and concurrent chemoradiotherapy (HR=0.213, 95%CI 0.11-0.43, P<0.001) were the independent predicators of PFS in patients with LACC. However, concurrent chemoradiotherapy (HR=0.229, 95%CI 0.07-0.81, P=0.023) and MLR (HR=4.933, 95%CI 1.39-17.54, P=0.014) before treatment were the independent predictors of OS in patients with LACC. Conclusions Patients with locally advanced cervical cancer can benefit from concurrent chemoradiotherapy. HR-CTV EQD2Gy is a critical prognostic factor of PFS in patients with LACC. The increase of MLR before treatment is an independent prognostic factor of OS in LACC patients.

Key words： Monocyte-lymphocyte ratio Cervical cancer, locally advanced/concurrent chemoradiotherapy Prognosis

收稿日期: 2020-10-22

基金资助:国家自然科学基金(U1603282);中国医学科学院肿瘤免疫研究和放疗研究重点实验室专项课题(2019PT310021)

通讯作者: 王若峥,Email:Wrz8526@vip.163.com

引用本文:

王玉婷,秦永辉,赵敏等. 疗前绝对淋巴细胞计数及其相关参数比对局部晚期宫颈癌患者疗效的预测价值[J]. 中华放射肿瘤学杂志, 2021, 30(1): 54-60.

Wang Yuting,Qin Yonghui,Zhao Min et al. Predictive value of absolute lymphocyte count and its related parameters before treatment in patients with locally advanced cervical cancer[J]. Chinese Journal of Radiation Oncology, 2021, 30(1): 54-60.

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[1] 乔友林. 中国宫颈癌防治任重而道远[J]. 中华肿瘤杂志, 2018, 40(10):721-723. DOI:10.3760/cma.j.issn.0253-3766.2018.10.001.
Qiao YL. A long journey of cervical cancer prevention in China[J]. Chin J Oncol, 2018, 40(10):721-723. DOI:10.3760/cma.j.issn.0253-3766.2018.10.001.
[2] Endo D, Todo Y, Okamoto K, et al. Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy:a retrospective analysis in a Japanese cohort[J]. J Gynecol Oncol, 2015, 26(1):12-18. DOI:10.3802/jgo.2015.26.1.12.
[3] Hussain SP, Harris CC. Inflammation and cancer:an ancient link with novel potentials[J]. Int J Cancer, 2007, 121(11):2373-2380. DOI:10.1002/ijc.23173.
[4] Davuluri R, Jiang W, Fang P, et al. Lymphocyte nadir and esophageal cancer survival outcomes after chemoradiation therapy[J]. Int J Radiat Oncol Biol Phys, 2017, 99(1):128-135. DOI:10.1016/j.ijrobp.2017.05.037.
[5] Tang C, Liao ZX, Gomez D, et al. Lymphopenia association with gross tumor volume and lung V5 and its effects on non-small cell lung cancer patient outcomes[J]. Int J Radiat Oncol Biol Phys, 2014, 89(5):1084-1091. DOI:10.1016/j.ijrobp.2014.04.025.
[6] Tan DW, Fu Y, Su Q, et al. Prognostic role of platelet-lymphocyte ratio in colorectal cancer:a systematic review and meta-analysis[J]. Medicine, 2016, 95(24):e3837. DOI:10.1097/MD.0000000000003837.
[7] Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium[J]. Int Federat Gynaecol Obstet, 2009, 105(2):103-104. DOI:10.1016/j.ijgo.2009.02.012.
[8] Semeniuk-Wojta?B A, Lubas A, Stec R, et al. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and c-reactive protein as new and simple prognostic factors in patients with metastatic renal cell cancer treated with tyrosine kinase inhibitors:a systemic review and meta-analysis[J]. Clin Genitourin Cancer, 2018, 16(3):e685-e693. DOI:10.1016/j.clgc.2018.01.010.
[9] 鲍优庭,赵文歌,李步托,等. 治疗前淋巴细胞减少与恶性实体瘤患者预后相关性Meta分析[J]. 中华肿瘤防治杂志, 2018, 25(13):968-975. DOI:10.16073/j.cnki.cjcpt.2018.13.010.
Bao YT, Zhao WG, Li BT, et al. Meta-analysis of the correlation between pretreatment lymphopenia and prognosis in malignant solid tumors[J]. Chin J Cancer Prevent Treat, 2018, 25(13):968-975. DOI:10.16073/j.cnki.cjcpt.2018.13.010.
[10] Choi CW, Sung HJ, Park KH, et al. Early lymphopenia as a risk factor for chemotherapy-induced febrile neutropenia[J]. Am J Hematol, 2003, 73(4):263-266. DOI:10.1002/ajh.10363.
[11] Ethier JL, Desautels D, Templeton A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer:a systematic review and meta-analysis[J]. Breast Cancer Res, 2017, 19(1):2. DOI:10.1186/s13058-016-0794-1.
[12] Ibrahim A, Serkan YF, Tuba A, et al. Can neutrophil to lymphocyte ratio be a predictor tool for the non-sentinel lymph node metastasis in breast cancer?[J]. Chirurgia, 2019, 114(1):83-88. DOI:10.21614/chirurgia.114.1.83.
[13] Kou FR, Lu ZH, Li J, et al. Pretreatment lymphopenia is an easily detectable predictive and prognostic marker in patients with metastatic esophagus squamous cell carcinoma receiving first-line chemotherapy[J]. Cancer Med, 2016, 5(5):778-786. DOI:10.1002/cam4.638.
[14] Joseph N, Dovedi SJ, Thompson C, et al. Pre-treatment lymphocytopaenia is an adverse prognostic biomarker in muscle-invasive and advanced bladder cancer[J]. Ann Oncol, 2016, 27(2):294-299. DOI:10.1093/annonc/mdv546.
[15] Guthrie GJK, Charles KA, Roxburgh CSD, et al. The systemic inflammation-based neutrophil-lymphocyte ratio:experience in patients with cancer[J]. Crit Rev Oncol Hematol, 2013, 88(1):218-230. DOI:10.1016/j.critrevonc.2013.03.010.
[16] 李晓惠,徐冰清,高劲,等. 中性粒细胞与淋巴细胞比值对鼻咽癌放射敏感性及预后影响的研究[J]. 中华放射肿瘤学杂志, 2016, 25(5):432-436. DOI:10.3760/cma.j.issn.1004-4221.2016.05.002.
Li XH, Xu BQ, Gao J, et al. Influence of neutrophil-lymphocyte ratio on radiosensitivity and prognosis in patients with nasopharyngeal carcinoma[J]. Chin J Radiat Oncol, 2016, 25(5):432-436. DOI:10.3760/cma.j.issn.1004-4221.2016.05.002.
[17] Huang QT, Man QQ, Hu J, et al. Prognostic significance of neutrophil-to-lymphocyte ratio in cervical cancer:a systematic review and meta-analysis of observational studies[J]. Oncotarget, 2017, 8(10):16755-16764. DOI:10.18632/oncotarget.15157.
[18] Yang J, Zhang LX, Yu CJ, et al. Monocyte and macrophage differentiation:circulation inflammatory monocyte as biomarker for inflammatory diseases[J]. Biomarker research, 2014, 2(1):1. DOI:10.1186/2050-7771-2-1.
[19] 唐英,李均,徐凡,等. 单核细胞与淋巴细胞比值及其与上皮性卵巢癌患者预后的关系[J]. 中华妇幼临床医学杂志(电子版), 2017, 13(5):532-538. DOI:10.3877/cma.j.issn.1673-5250.2017.05.006.
Tang Y, Li J, Xu F, et al. Association between monocyte-to-lymphocyte ratio and prognosis of patients with epithelial ovarian cancer[J]. Chin J Obstet Gynecol Pediat (Elect ed), 2017, 13(5):532-538, DOI:10.3877/cma.j.issn.1673-5250.2017.05.006.
[20] Shi C, Pamer EG. Monocyte recruitment during infection and inflammation[J]. Nat Rev Immunol, 2011, 11(11):762-774. DOI:10.1038/nri3070.
[21] Coussens LM, Werb Z. Inflammation and cancer[J]. Nature, 2002, 420(6917):860-867. DOI:10.1038/nature01322.
[22] Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation[J]. Nature, 2008, 454(7203):436-444. DOI:10.1038/nature07205.
[23] Hamilton G, Rath B, Klameth L, et al. Small cell lung cancer:recruitment of macrophages by circulating tumor cells[J]. Oncoimmunology, 2016, 5(3):e1093277. DOI:10.1080/2162402X.2015.1093277
[24] Ma JY, Ke LC, Liu Q. The pretreatment platelet-to-lymphocyte ratio predicts clinical outcomes in patients with cervical cancer:a meta-analysis[J]. Medicine, 2018, 97(43):e12897. DOI:10.1097/MD.0000000000012897.
[25] 赵志鹏,管薇,赵红福,等. 3D打印模板辅助标准化施源器在ⅢB期宫颈癌影像引导自适应近距离治疗中的应用[J]. 中华放射肿瘤学杂志, 2020, 29(8):661-665. DOI:10.3760/cma.j.cn113030-20200511-00246.
Zhao ZP, Guan W, Zhao HF, et al. Application of 3D printing technology-assisted standardized applicator in image-guided adaptive brachytherapy of stage ⅢB cervical cancer[J]. Chin J Radiat Oncol, 2020, 29(8):661-665. DOI:10.3760/cma.j.cn113030-20200511-00246.
[26] 赵秀娟,李林,唐郢,等. 阴道消除量联合放化疗对巨块型ⅢB期宫颈鳞癌的疗效分析[J]. 中国肿瘤临床, 2020, 47(6):289-293. DOI:10.3969/j.issn.1000-8179.2020.06.350.
Zhao XJ, Li L, Tang Y, et al. Analysis of vaginal elimination combined with radiotherapy and chemotherapy for giant stage ⅢB cervical squamous cell carcinoma[J]. Chin J Clin Oncol, 2020, 47(6):289-293. DOI:10.3969/j.issn.1000-8179.2020.06.350.